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ADVANCE Perspective: Nurses

CNAs as School Nurses: A Good Idea?

Published August 31, 2011 11:10 AM by Pam Tarapchak

As students in Salisbury, MD, head back to the days of homework and bus rides, the Wicomico County school district has decided to replace three registered nurses with certified nursing assistants, leaving some schools without an RN to care for children with medical needs that can't be handled by a CNA.

"We've had to be very strategic with staffing," said Margo Handy, the school district's assistant superintendent, as quoted in The Daily Times. "You're going to see this story in a lot of areas as the year goes on. We're looking at a lot of ways to do reorganizing as we anticipate future funding or lack of funding."

It's true: School districts across the country are making tough choices to save money. But should it be at the expense the students' healthcare needs? The newspaper article did note the schools that have the most medically fragile students (e.g., those needing catheterization or tube feedings) will still have two RNs on staff. But what about the one student in one of the other schools who needs more care than a CNA can provide?

The financial bottom line: It was reported the elimination of three RN positions at the school saved $168,707 annually.

To me, it seems like a small amount to pay to ensure the district's students remain healthy.




The fact that CNAs cannot even make nursing judgments regarding medication dispensing and reactions, is reason enough not to have them as the primary person in charge of the needs of school children. The liability issues are monstrous, but the potential harm to the children is incalculable. CNAs have a very important place in the rendering of patient care. But no where in the practice act does that include being in charge of nursing assessment and  evaluation of care. The mind reals that money could be the overriding issue; however, as a former school nurse, I am not surprised.

When I took over a four school district, the control drugs were in the unsupervised principal's desk, they were dispensed whenever a child came and asked for a dose (whenever they asked!), by anyone the child could get to dispense them, no records were kept, and no parental permission was ever obtained.

And worse, it took me an entire year and a grievance to convince the district that the LPNs were practicing on my license and 'Yes,' I would, in fact, supervise them.

CNAs without direct RN supervision are a disaster of magnificent proportions. The children will be the fall out.

Dalton Blankenship, Former School Nurse, Nat'l Cert - RN BS NCSN September 13, 2011 1:23 PM
Honea Path SC

I am dumbfounded at the decision - you cannot replace nursing responsibilities and assessment with non-nursing personnel. Did the schools risk management or legal department not render an opinion on this?

Kelly, Critical Care - CNS September 5, 2011 2:31 PM

This is a very bad idea. A CNA (nor an LPN for that matter) may make nursing assessments independently so what happens when the CNA is needed to do something out of her/his scope of practice? This has so many liability problems that could arise, the school will end up spending much more that the$ 165K should a lawsuit come about...

Nina, substance abuse/psych - RN August 31, 2011 11:50 AM

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